Modelling the cost-effectiveness of pay-for-performance in primary care in the UK

BMC Medicine
Ankur PandyaAndrew M Ryan

Abstract

Introduced in 2004, the United Kingdom's (UK) Quality and Outcomes Framework (QOF) is the world's largest primary-care pay-for-performance programme. Given some evidence of the benefits and the substantial costs associated with the QOF, it remains unclear whether the programme is cost-effective. Therefore, we assessed the cost-effectiveness of continuing versus stopping the QOF. We developed a lifetime simulation model to estimate quality-adjusted life years (QALYs) and costs for a UK population cohort aged 40-74 years (n = 27,070,862) exposed to the QOF and for a counterfactual scenario without exposure. Based on a previous retrospective cross-country analysis using data from 1994 to 2010, we assumed the benefits of the QOF to be a change in age-adjusted mortality of -3.68 per 100,000 population (95% confidence interval -8.16 to 0.80). We used cost-effectiveness thresholds of £30,000/QALY, £20,000/QALY and £13,000/QALY to determine the optimal strategy in base-case and sensitivity analyses. In the base-case analysis, continuing the QOF increased population-level QALYs and health-care costs yielding an incremental cost-effectiveness ratio (ICER) of £49,362/QALY. The ICER remained >£30,000/QALY in scenarios with and without non-...Continue Reading

References

Jan 1, 1985·Medical Decision Making : an International Journal of the Society for Medical Decision Making·P DoubiletB J McNeil
Nov 21, 1997·Medical Care·P Dolan
May 5, 1998·Medical Decision Making : an International Journal of the Society for Medical Decision Making·A A Stinnett, J Mullahy
Oct 2, 2004·The New England Journal of Medicine·Martin Roland
May 13, 2006·Medical Care Research and Review : MCRR·Tammie A NahraJohn R C Wheeler
Jul 21, 2006·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Patrick W Sullivan, Vahram Ghushchyan
Jul 28, 2006·The New England Journal of Medicine·Tim DoranMartin Roland
Jul 25, 2009·The New England Journal of Medicine·Stephen M CampbellMartin Roland
Apr 29, 2010·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Simon WalkerMark Sculpher
May 5, 2010·Health Affairs·Tim Doran, Martin Roland
Sep 21, 2010·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Robert FleetcroftNicholas Steel
Mar 23, 2011·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Patrick W SullivanVahram Ghushchyan
Jun 11, 2011·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Martin EmmertOliver Schöffski
Nov 5, 2011·Journal of the American Medical Informatics Association : JAMIA·Daria O'ReillyRon Goeree
Jun 29, 2012·Circulation. Cardiovascular Quality and Outcomes·Kate SmolinaMichael J Goldacre
Sep 20, 2012·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Mark RobertsUNKNOWN ISPOR-SMDM Modeling Good Research Practices Task Force
Nov 9, 2012·The New England Journal of Medicine·Matt SuttonMartin Roland
Feb 6, 2013·Health Policy·Frank EijkenaarOliver Schöffski
Mar 7, 2014·BMJ : British Medical Journal·Tim DoranAndrew M Ryan
Aug 8, 2014·The New England Journal of Medicine·Søren Rud KristensenMatthew Sutton
Apr 5, 2016·European Heart Journal. Quality of Care & Clinical Outcomes·Simon WalkerMark Sculpher
Aug 7, 2016·BMJ : British Medical Journal·Martin Roland, Bruce Guthrie

❮ Previous
Next ❯

Citations

May 28, 2021·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Simon WalkerMark Sculpher

❮ Previous
Next ❯

Software Mentioned

Excel
QOF
Visual Basic for Applications ( VBA
Visual Basic for Applications

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.